Is the PPACA a Good Policy?

The editors of the Pittsburgh Post-Gazette to remonstrate with those who complain that the president lied about the PPACA. So what? It’s still a good policy:

Plans are being canceled because they don’t meet the coverage set out in the Affordable Care Act and leave many people poorly insured. Those Americans who have been canceled can obtain other policies that may be more or less costly but should offer them better coverage than before.

In short, the furor of the supposed great lie is an embarrassment to Mr. Obama, but it obscures the larger and more important truth that the Affordable Care Act remains good policy.

Is it? I’d like to see somebody make the case. What I’ve seen is people defending the idea of the PPACA or its possible future evolution. If you’re defending the PPACA, here’s what you need to defend. The estimate of people without healthcare insurance is between 30 million and 50 million people. According to the CBO, no more than a third of those would be insured under the terms of the PPACA. Consequently, you need to defend the PPACA not on the basis that it insures everybody or that someday everybody might be insured but that leaving between 20 million and 40 million people uninsured is just fine.

You need to defend the PPACA’s expansion of the Medicaid paid by the states beyond their ability to pay. You need to defend the cancellation of hundreds of thousands or millions of people’s insurance not on the basis of their potentially getting better insurance someday but on the basis that they shouldn’t have had even the insurance they had.

I wish them the best of luck. The key point is not merely that the PPACA is bad but that it is inadequate and doesn’t provide the path to future improvement its advocates think it will.

The other day in comments over at OTB a frequent commenter made what I think is the best and most succinct summary of the PPACA I’ve ever read: it was the least disruptive meaningful change the Democrats in Congress thought they could enact. IMO with respect to our healthcare system disruption is directly proportional to meaning.

Here’s my less than fifty word synopsis of our healthcare system. It provides pretty fair healthcare for those who can afford it. It’s mostly subsidized and the subsidies are determined based on political expediency rather than need or merit. Most of the benefits of the subsidies go to providers, stockholders, and the wealthy.

I think that’s a system that needs more disruption rather than less.

5 comments… add one
  • Jimbino

    The idea of PPACA is to throw money to insurance companies, hospitals, docs and drug and device manufacturers. If we were truly interested in health care for the masses, we’d have a plan to get them treated in Cuba, Mexico, Thailand, India, Hungary, Prague and Costa Rica, where the care costs a fraction of what it costs in the USSA.

  • PD Shaw

    The goal of the ACA was to expand service. It will probably have done so for some targets groups and not others.

    WINNERS:
    People w/ Pre-Existing Conditions who Previously Couldn’t Get Insurance and Can Afford the New Coverage
    Children of Parents with Insurance up to age 26.
    Expanded Medicaid Enrollees
    Sandra Fluke

    LOSERS
    People who couldn’t afford coverage then and now
    Children that previously benefited from Child-Only policies w/o Parents w/ good insurance
    People who had good, economical insurance in the independent market
    Young Adults, due to cost-shift to benefit Pre-Medicare Boomers

    SPECIAL LOSERS
    Health Care Reform Advocates, Conservative or Liberal

  • PD Shaw

    Probably should add to LOSERS:

    Rural residents, but in particular those living near/around state borders. If they had insurance on the individual market that gave them access to services in a larger metro in a neighboring state, they may no longer.

  • Another group to add to losers: people who live in one state and receive medical treatment in another.

  • Red Barchetta

    I’m distressed by the “winners/losers” lines. This is health care. Its not about who wins or loses, unless you punt the issue to politics. And that’s what we did and what we have.

    It should be about an efficacious system. Instead, we had a largely government induced problem being fixed……….no, altered for political gain, that does not address legitimate issues.

    Same as it ever was.

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